Abstract
HIV-associated neurocognitive disorders (HAND) are frequently associated with impaired executive function and verbal fluency. Given limited knowledge concerning HAND in Sub-Saharan-Africa and lack of Cameroonian adult neuropsychological (NP) test norms, we administered four executive function [Halstead Category Test (HCT), Wisconsin Card Sorting Test (WCST), Color Trails-II (CTT2), and Stroop Color-Word-Interference (SCWT)] and three verbal fluency (Category, Action, and Letter Fluency) tests to 742 adult Cameroonians (395 HIV−, 347 HIV+). We developed demographically-corrected NP test norms and examined the effects of HIV and related variables on subjects’ executive function and verbal fluency. HIV+ subjects had significantly lower T-scores on CTT2 (P = 0.005), HCT (P = 0.032), WCST (P < 0.001); lower executive function composite (P = 0.002) and Action Fluency (P = 0.03) T-scores. ART, viremia, and CD4 counts did not affect T-scores. Compared to cases harboring other viral subtypes, subjects harboring HIV-1 CRF02_AG had marginally higher CTT2 T-scores, significantly higher SCWT (P = 0.015) and executive function (P = 0.018) T-scores. Thus, HIV-1 infection in Cameroon is associated with impaired executive function and some aspects of verbal fluency, and viral genotype influenced executive function. We report the first normative data for assessing executive function and verbal fluency in adult Cameroonians and provide regression-based formulas for computing demographically-adjusted T-scores. These norms will be useful for investigating HIV/AIDS and other diseases affecting cognitive functioning in Cameroon.
Highlights
HIV enters the CNS in the early stages of infection, where it productively infects brain macrophages and microglia and can induce injury and dysfunction of neurons and other CNS cells[1,2]
Since the beginning of the HIV/AIDS epidemic over 3 decades ago, Sub-Saharan Africa (SSA) has consistently been the hardest hit region in the world, and most of the 35 million people who have died from HIV/AIDS-related illnesses since the start of the epidemic were in SSA
Executive function and verbal fluency are both supported by the frontal lobes, and impairments in these cognitive domains correlate with damage to frontal brain systems[27,30,31,32]
Summary
HIV enters the CNS in the early stages of infection, where it productively infects brain macrophages and microglia and can induce injury and dysfunction of neurons and other CNS cells[1,2]. It has been shown that the cognitive domains most likely impaired in HIV/AIDS patients include executive function[3,5,19,20,21,22] and verbal fluency[5,23,24]. Executive function and verbal fluency are both supported by the frontal lobes, and impairments in these cognitive domains correlate with damage to frontal brain systems[27,30,31,32]. These cognitive abilities are assessed using neuropsychological (NP) tests. We adjusted the data for demographic factors (age, gender, and education), and further assessed the effects of HIV infection, immune status, ART, viremia and viral genotype on subjects’ performance on these NP tests
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